426216547-3-15-2023-17-CC-MBRT-CPXPFW-20230315111724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216547
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:17:29 AM

Document Has Been Signed on 03/15/2023 11:17 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	LUNA FAMILY CHILD CARE HOME		FACILITY NUMBER:	426216547
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	03/15/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Amanda Luna		TIME COMPLETED:	11:26 AM

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On March 15^th, 2023, at 9:25 AM, Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a pre-licensing inspection. LPA met with applicant Amanda Luna. Present in the home was husband Daniel Luna – fingerprint cleared.

LPA and applicant toured the home together. During this tour the following was noted:

Family members residing in the home are two (2) adults - applicant, and husband. No children reside in the home. Per applicant, the operating hours will be Monday through Friday from 7:30AM-5:00PM

All areas identified on the facility sketch were inspected. This is a single story home which consists of three (3) bedrooms, one (1) bathroom, one (1) living room, kitchen, dining room, laundry room, garage, and outdoor play area. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Off limit areas are as follows: one (1) bedroom (master), one (1) office (converted bedroom), kitchen, laundry room and garage.

Applicant stated that children will have access to: Living room, dining room, bathroom, one (1) bedroom (converted playroom), and outdoor play yard.

Applicant states the front yard will be inaccessible to children and children will enter through side path. There is an additional home on the property, vacant, and with a separate address – not affiliated with the Family Child Care Home (FCCH) There are age-appropriate toys and napping equipment on the premises. Medication for the family is stored out of children’s reach, inaccessible to children in an elevated cabinet the bathroom. First Aid and emergency kits are available. Applicant states opening of FCCH will be 5/30/2023. Currently, the outdoor is under construction. LPA toured the prospective perimeter that will have regulatory fencing by 5/30/2023. Indoors, LPA advised applicant is required to have gate or locks in kitchen, master bath, office, and laundry room. Toxins and poisons are to be elevated in the bathroom or stored under sink secured with a lock.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LUNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 426216547
	VISIT DATE: 03/15/2023

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The required fire extinguisher 2A10BC was purchased on 5/30/2023. Carbon Monoxide detector was tested at 9:36AM and functioning at the time of the inspection. Fire alarm was tested at 9:58AM and functioning at the time of the inspection. Applicant is reminded to purchase a new or service fire extinguisher yearly. Per applicant, there are no firearms or ammunition in the home. No bodies of water are present.

The applicant completed the FCCH Orientation on 6/9/2022. The applicant has current Pediatric First Aid and CPR which expires 8/31/2023. Applicant took the Preventative Health Training on 9/29/2022. Applicant’s Mandated Reporter Training expires on 11/11/2023.

LPA reviewed with applicant the LIC311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant, provided applicant with Safe Sleep Information handout, and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LUNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 426216547
	VISIT DATE: 03/15/2023

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

At this time, the facility does not meet the Title 22 Division 12 requirements for a Family Child Care Home. Licensure is pending:

· Perimeter fencing of the outdoor area.

· Removal of or locked storage of bathroom toxins and poisons.

· Placement of either gates or locks for kitchen and laundry room.

Applicant stated she will provide proof of corrections to LPA by 5/30/2023.

An exit interview was conducted, and report provided to applicant.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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